Malaria afflicts millions in low-and middle-income countries and is one of the world's most important public-health concerns. It causes over a million deaths and more than 500 million clinical cases each year. Most of the 3,000 deaths each day (10 new cases every second) are in Sub-Saharan Africa, and more than a third of the world's total population now lives in areas where malaria thrives. The disease also takes a high toll on households, productivity, and health care systems, which in turn affects development. We estimate that malaria reduces GDP growth by around one full percentage point each year. The disease is preventable, curable, and controllable on a large scale, with good returns on investment. The World Bank's Commitment to Roll Back Malaria As a founding partner of Roll Back Malaria (RBM), the World Bank has been actively involved in efforts to reduce the global burden of malaria by informing national priorities, advocating for innovative approaches to reducing the burden of malaria, and working with client countries to expand their capacity to effectively request and absorb additional resources to address malaria. In addition, the Bank has supported research and analytic work on the financing and economics of malaria, has advocated for rationalization of national policies on taxes and tariffs on essential malaria commodities (e.g. insecticide treated nets), and has fostered an increased role of industry and the private sector in efforts toward attaining the goals of RBM. There are more than 25 World Bank projects in the Africa Region that currently provide support for malaria control activities. The Bank has declared malaria a corporate priority, in support of achieving the Millennium Development Goals. The Africa Region has assigned a Bank Task Force to accelerate country efforts to control malaria. The World Bank in Partnership The Roll Back Malaria (RBM) partnership was launched jointly by the World Bank, WHO, UNICEF, and UNDP in November 1998. It responds to the concerns of Heads of State in many malaria-affected countries, and to the particular problems faced by their poor communities. RBM is a global partnership of a wide range of agencies and individuals committed to reducing the burden of malaria, including malaria-affected countries, multilateral and bilateral development agencies, non-governmental organizations, the research community, industry, the private sector and the media. The goal of RBM is to halve the global burden of malaria (morbidity and mortality) by the year 2010. Reduction of malaria burden is also included in the Millennium Development Goals (MDGs). The challenge that RBM currently faces is building effective partnerships at country-level that will lead to nationwide implementation of proven, cost-effective malaria control strategies. This is the scale of action required if the burden of malaria is to be continuously rolled back. The World Bank has played a leadership role in international efforts to address the high cost of combination drug treatment for malaria. As chloroquine, the drug most commonly used to treat malaria over the years, has lost its effectiveness in Africa, countries are faced with moving to combination therapies that cost up to $2 per adult treatment (almost 20 times the cost of chloroquine). The Bank, with the US Institute of Medicine, brought together experts in economics, pharmaceutical management, and public health from around the world to review possible actions to make effective malaria treatment more widely available. The recommendations of this meeting helped to spur the RBM Partnership to take decisive action by establishing a Malaria, Medicines and Supply Service which will support countries with up-to-date information on manufacturers and prices of combination therapies and other essential products (e.g. insecticides, mosquito nets etc.), promote and monitor their quality, develop detailed forecasts of requirements to ensure that manufacturers scale-up production to meet demand, and broker pooling of procurement to reduce cost. The World Bank's Investments in Malaria Control Activities at the Country Level Since 2000, total Bank commitments in all regions are about US$100–150 million in earmarked funds for malaria control. These include only health sector investment credits and grants, as well as commitments through broad programmatic operations such as Sector-Wide Approaches (SWAps). Total World Bank support for malaria control was higher, due to financing through debt relief, multi-sectoral operations such as PRSCs, Emergency Recovery Credits, and Social Funds. In some countries, such as Brazil, Eritrea, India, and Vietnam we responded to requests for malaria-specific investment projects. The combination of country commitment and Bank support has shown that successes are possible. For example, Eritrea has reduced the number of deaths caused by malaria for four years in a row and has seen the use of Insecticide Treated Nets (ITNs) rise from 20% in 2000 to 58.5% in 2002. Contributors to Eritrea’s success included: - a $40 million IDA credit for HIV/AIDS, malaria, sexually-transmitted diseases and tuberculosis; and
- technical support from and partnership with USAID.
In 2002 to 2003, India achieved dramatic reductions in malaria death rates in Gujarat (58%), Maharashtra (98%) and Rajasthan (79%) through the Bank-supported Enhanced Malaria Control Project. As well as financing malaria control activities, we contribute to the Roll Back Malaria (RBM) Partnership by providing technical expertise in areas of financing and economics. In Africa, progress in malaria control has fallen short of the targets set for 2005. With the increase in drug-resistant malaria, the problem is getting worse in many places; at US$1–2 per course of treatment, the new and effective drugs are 10–20 times as expensive as the older drugs. In September 2004, we started working on an updated Global Strategy and Program of Action to boost the fight against malaria. The document, which we will publish on 25 April 2005 (Africa Malaria Day) will describe a significant upgrade of the World Bank’s support for malaria control, with emphasis on closing the gap between knowing and doing. The Global Strategy and Program of Action provides the basis for a new Booster Program for Malaria Control, which will accelerate worldwide malaria control and progress toward the Millennium Development Goals. Examples of Project Success In Uganda, the Bank has supported the implementation of Integrated Management of Childhood Illnesses (IMCI), a core strategy for management of malaria in children (who bear the greatest burden from the disease), in 35 of the country's 39 districts. In addition, support has been provided for the promotion of insecticide treated nets (ITNs) in 13 districts. In Madagascar, Bank investments for improved case management and vector control activities helped reduce the frequency of infected mosquito bites from 4.76 per person-year to 1.0 per person-year. In highland areas, the frequency of malaria infection decreased to 0.8 percent in intervention areas compared to 6.5 percent in other areas. Eritrea, with financial and technical support provided by the Bank-financed HAMSET project, has demonstrated reductions in malaria morbidity and mortality for five successive years. Last year, while neighboring countries experienced malaria epidemics after heavy rains, Eritrea’s case load decreased. In Vietnam, the Government approved the National Health Support Project (1996-2003) which provided support to the national malaria control program which helped eradicate malaria in all but 4 of the 15 provinces covered by the project. The Bank is leading the RBM Partnership’s initiative to ensure that malaria control activities are highly prioritized in countries undergoing health sector reforms and are employing Sector-Wide Approaches. Over the past year, the Bank has acted to address this challenge in Ghana, Kenya, Rwanda, and Senegal. In Ghana, for instance, a joint World Bank-WHO effort responded to the country’s desire to more aggressively fight malaria by helping to remove bureaucratic bottlenecks and provide the opportunity to draw down on the Bank’s committed resources to accelerate malaria control efforts.
For more information on the World Bank’s work in Health, Nutrition and Population, please visit our website at www.worldbank.org/hnp. For more information on Roll Back Malaria Partnership, please visit www.rbm.who.int.
Updated April 2005
Media Contacts:
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